SOS Student Screening Form
Grade in School *
Gender *
Are you currently being treated for depression *
Brief Screen for Adolescent Depression
These questions are about feelings that people sometimes have and things that may have happened to you. Most of the questions are about the LAST FOUR WEEKS. Read each question carefully and answer it by checking the correct response.
1. In the last for weeks, has there been a time when nothing was fun for you and you just weren't interested in anything? *
2. Do you have less energy than you usually do? *
3. Do you feel you can't do anything well or that you are not as good-looking or as smart as most other people? *
4. Do you think seriously about killing yourself? *
5. Have you tried to kill yourself IN THE LAST YEAR? *
6. Does doing even little things make you feel really tired? *
7. In the last four weeks has it seemed like you couldn't think as clearly or as fast as usual? *
Identifying Trusted Adults
List a trusted adult you could turn to if you need help for yourself or a friend (example: "My English teacher", "school counselor", "school social worker", "my mother," "uncle," etc.)
In school *
Out of school *
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This form was created inside of Kings Canyon Unified School District.